José Almenara

Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies

To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults.

Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis

BACKGROUND Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt. METHODS We searched 6 databases until June 2015. INCLUSION CRITERIA 1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated. RESULTS From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%. LIMITATIONS There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts. CONCLUSIONS Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.

Assessment of service use patterns in out-patients with schizophrenia: a Spanish study

Objective:  The objective is to describe and characterize patterns of service use by out‐patients with schizophrenia in Spain.

Basic concepts in the taxonomy of health-related behaviors, habits and lifestyle.

Background: Health-related Habits (HrH) are a major priority in healthcare. However there is little agreement on whether exercise, diet, smoking or dental hygiene are better described as lifestyles, habits or behaviors, and on what is their hierarchical relationship. This research is aimed at representing the basic concepts which are assumed to constitute the conceptual framework enabling us to interpret and organize the field of HrH. Methods: A group of 29 experts with different backgrounds agreed on the definition and hierarchy of HrH following an iterative process which involved framing analysis and nominal group techniques. Results: Formal definitions of health-related behavior, habit, life-style and life-style profile were produced. In addition a series of basic descriptors were identified: health reserve, capital, risk and load. Six main categories of HrH were chosen based on relevance to longevity: diet/exercise, vitality/stress, sleep, cognition, substance use and other risk. Attributes of HrH are clinical meaningfulness, quantifiability, temporal stability, associated morbidity, and unitarity (non-redundancy). Two qualifiers (polarity and stages of change) have also been described. Conclusions: The concepts represented here lay the groundwork for the development of clinical and policy tools related to HrH and lifestyle. An adaptation of this system to define targets of health interventions and to develop the classification of person factors in ICF may be needed in the future.

Mortality and morbidity of newly diagnosed heart failure with preserved systolic function treated with β-blockers: A propensity-adjusted case–control populational study

BACKGROUND The effect of treatment with β-blockers on the prognosis of patients newly diagnosed with heart failure with preserved systolic function (HF-PSF) is unknown. OBJECTIVES To analyze the relationship of commencing treatment with the β-blockers bisoprolol or carvedilol (CT-βB) with the mortality and the morbidity of newly diagnosed HF-PSF. METHODS Prospective propensity-adjusted cohort study over 5 years on 1085 adults diagnosed with HF-PSF for the first time, in an integrated university-based health organization in Spain. The independent relationship between CT-βB and mortality and morbidity was analyzed, stratifying patients for comorbidity, after a multivariable adjustment for potential confounders. RESULTS The 378 patients (34.8%) who CT-βB were more frequently older women, with more cardiovascular comorbidity. Of the total patients 554 (51.0%) died, and 711 (65.5%) were hospitalized. Using an intent-to-treat approach, CT-βB was associated with a lower risk of mortality (all-cause: RR [CI 95%] 0.37 [0.21 to 0.50], and cardiovascular: 0.31 [0.18 to 0.45]), and a lower age- and sex-adjusted hospitalization rate (per 100 persons/year), 13.6 vs. 19.2, (P<0.001 in all cases), even after adjustment for the propensity to take β-blockers, or other medications, comorbidities, and other potential confounders. CONCLUSIONS In this observational study, commencing treatment with the β-blockers bisoprolol or carvedilol is associated with a reduced mortality and morbidity of patients with newly diagnosed heart failure with preserved systolic function.

Estudio de variables asociadas al cáncer de piel en Chile mediante análisis de componentes principales

Resumen Fundamento La incidencia de cancer de piel en Chile ha aumentado en los ultimos anos. Objetivo Asociar variables al cancer de piel en Chile a traves de indices generados mediante tecnicas estadisticas descriptivas multivariantes. Material y metodo Durante el mes de mayo de 2004 se recopilo informacion de datos demograficos, meteorologicos y clinicos de Chile, correspondientes al ejercicio 2001, ultima informacion completa y oficial disponible para la totalidad de los Servicios de Salud del pais. Se estudiaron las variables confeccionadas por el Instituto Nacional de Estadistica (INE), el Ministerio de Salud (MINSAL), el Ministerio de Planificacion y Cooperacion (MIDEPLAN), el Fondo Nacional de Salud (FONASA), la Direccion Meteorologica de Chile, la Universidad Tecnica Federico Santa Maria y la Direccion General de Aguas. Se aplico a los datos obtenidos un analisis de components principales (ACP). Resultados Se seleccionaron las tres primeras components principales, con un porcentaje acumulado de variabilidad explicada de 54,48 %. La primera componente principal explica el 24,92 % de la variabilidad y tiene relacion con variables del orden climatico y geografico. La segunda componente principal explica el 15,77 % de la variabilidad y se relaciona principalmente con la poblacion beneficiaria de FONASA y el indice de pobreza. En ella se opone de manera importante la tasa de letalidad por cancer cutaneo. La tercera componente principal explica el 13,79% de la variabilidad y se relaciona con caracteristicas poblacionales como poblacion total asignada, poblacion femenina y poblacion urbana. Conclusion La aplicacion del ACP es util para el estudio de los factores asociados con el cancer de piel.

Mortality and morbidity of non-systolic heart failure treated with angiotensin-converting enzyme inhibitors: a propensity-adjusted case-control study.

BACKGROUND The effect of treatment with angiotensin-converting enzyme inhibitors (ACEIs) on the prognosis of patients newly diagnosed with heart failure with preserved systolic function (HF-PSF) is unclear. We evaluate the relationship of commencing ACEI therapy (C-ACEI-T) with the morbidity and mortality of patients with HF-PSF. METHODS Prospective propensity-adjusted cohort study over 5 years on 1120 adults diagnosed with HF-PSF for the first time, within an integrated health organization in Spain. We analyzed the independent relationship between C-ACEI-T and mortality, and morbidity, stratifying patients according to comorbidity, after a multivariable adjustment for potential confounders. RESULTS The 865 patients (77.2%) who C-ACEI-T were younger, with more cardiovascular comorbidity. During the median follow-up of 908.3 days (interquartile range 558.6-1302.0) 580 patients (51.8%) died, and 727 (64.9%) were hospitalized. Using an intention-to-treat analysis, C-ACEI-T was associated with a lower risk of all-cause (RR [CI 95%] 0.34 [0.23 to 0.46]), and cardiovascular (RR 0.28 [0.20 to 0.36]) mortality, and a lower age- and sex-adjusted rate of hospitalization (per 100 persons-year), 12.3 vs. 19.4, (P<0.001 in all cases), even after adjustment for the propensity to take ACEIs, or other medications, comorbidities, and other potential confounders. CONCLUSION In this prospective observational study the establishment of ACEI therapy is associated with a reduced mortality and morbidity of patients with newly diagnosed non-systolic heart failure.

Nueva propuesta de indicadores de gestión de los servicios médico-quirúrgicos mediante técnicas estadísticas multivariantes

Resumen Objetivo Obtener indicadores utiles para la gestion hospitalaria mediante la utilizacion de tecnicas estadisticas multivariantes descriptivas. Material y metodo Durante abril del ano 2006 se analizo la informacion del Hospital Clinico de la Universidad de Chile correspondiente a los egresos hospitalarios del ano 2003. Se estudiaron las variables monitorizadas por la Gerencia de Operaciones del Hospital Universitario: numero de egresos, tasa de letalidad, tasa de reingresos, numero de consultas externas, numero de dias de camas ocupadas, estadia en unidad de cuidados intensivos, edad de los pacientes e indice de complejidad quirurgica. Las variables se midieron para un total de 24.345 egresos. Aplicamos la tecnica de analisis de componentes principales (ACP), y se utilizo la matriz de correlaciones R. Resultados Se seleccionaron las primeras 2 componentes, con un porcentaje acumulado de variabilidad del 71,3%: del 49,4%, la primera, y del 21,9%, la segunda. Conclusiones La primera componente puede ser relacionada a un nuevo indice que tiene que ver con la dificultad de los casos atendidos; lo hemos denominado complejidad asistencial . La segunda explicaria la cuantia de personas atendidas, y denominamos demanda asistencial . Ambos indices nos permiten dar una clasificacion de los servicios hospitalarios.

Mental disorders as risk factors for suicidal behavior in young people: a meta-analysis and systematic review of longitudinal studies

BACKGROUND Suicide is the second leading cause of death for young people. OBJECTIVE To assess mental disorders as risk factors for suicidal behaviour among adolescents and young adults including population-based longitudinal studies. METHOD We conducted a systematic literature review. Bibliographic searches undertaken in five international databases and grey literature sources until January 2017 yielded a total of 26,883 potential papers. 1701 full-text articles were assessed for eligibility of which 1677 were excluded because they did not meet our eligibility criteria. Separate meta-analyses were conducted for each outcome (suicide death and suicide attempts). Odds ratio (OR) and 95% confidence intervals (95%CI) and beta coefficients and standard errors were calculated. RESULTS 24 studies were finally included involving 25,354 participants (12-26 years). The presence of any mental disorder was associated with higher risk of suicide death (OR = 10.83, 95%CI = 4.69-25.00) and suicide attempt (OR = 3.56; 95%CI 2.24-5.67). When considering suicidal attempt as the outcome, only affective disorders (OR = 1.54; 95%CI = 1.21-1.96) were significant. Finally, the results revealed that psychiatric comorbidity was a primary risk factor for suicide attempts. LIMITATIONS Data were obtained from studies with heterogeneous diagnostic assessments of mental disorders. Nine case-control studies were included and some data were collected in students, not in general population. CONCLUSIONS Mental disorders and comorbidity are strong predictors of suicide behaviour in young people. Detection and management of the affective disorders as well as their psychiatric comorbidity could be a crucial strategy to prevent suicidality in this age group.

Estudio de la dinámica de servicios hospitalarios mediante la utilización de técnicas estadísticas multivariables: el caso del Hospital Clínico de la Universidad de Chile

Resumen Objetivo Obtener indicadores utiles y dinamicos para la gestion hospitalaria mediante analisis de componentes principales. Material y metodo Se analizo la informacion del Hospital Clinico de la Universidad de Chile correspondiente a la actividad de los servicios medicoquirurgicos desde enero de 2003 a diciembre de 2004. Las variables analizadas fueron: numero de altas, tasa de letalidad, tasa de reingresos, numero de consultas externas, numero de dias de camas ocupadas e indice de complejidad quirurgica. Aplicamos la tecnica de analisis de componentes principales (ACP), y se utilizo la matriz de correlaciones R. Resultados Se seleccionaron los primeros 2 componentes para cada ano, que dieron cuenta del 75,92% de la variabilidad en los datos: el 47,02% el primero y el 28,9% el segundo. El primer componente se puede interpretar como un nuevo indice relacionado con la complejidad asistencial y el segundo, con la demanda asistencial. Conclusiones La utilizacion de estos nuevos indicadores permitiria categorizar los servicios hospitalarios y supervisar su rendimiento, lo que facilitaria la implementacion de medidas de correccion.